Case Management Coordinator – Transition of Care Team
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Job Description
Remote Case Management Coordinator supporting CVS Health members with care plans, appointments, benefits, and healthcare access. Evaluating needs and coordinating quality-focused interventions.
Responsibilities:
- Evaluate referred members' needs and eligibility using care management tools and data review
- Recommend approaches to case resolution and meeting members' needs
- Identify high-risk factors and service needs affecting outcomes and care planning
- Refer members to clinical case management or crisis intervention when appropriate
- Coordinate and implement assigned care plan activities
- Monitor care plan progress
- Consult with case managers, supervisors, Medical Directors, and other health programs to overcome barriers
- Present cases at multidisciplinary case conferences
- Identify and escalate quality-of-care issues
- Negotiate appropriate options and services for members' benefit and healthcare needs
- Use influencing and motivational interviewing skills to engage members and promote lifestyle or behavior changes
- Provide coaching, information, and support for independent medical and healthy lifestyle choices
- Help members participate knowledgeably in healthcare decision-making with providers
- Apply case management and quality management processes in compliance with regulatory, accreditation, and company guidelines
- Schedule appointments and assist members with accessing benefits, education, and services
Requirements:
- 2+ years of experience in behavioral health or social services
- Ability to work 8:00 AM–5:00 PM in the assigned market time zone
- 2+ years of experience with Microsoft Office Applications (Word, Excel, Outlook)
- Dedicated workspace free of interruptions
- Separate care arrangements for dependents during work hours
- Case management and discharge planning experience preferred
- Managed care experience preferred
- Bachelor's Degree or non-licensed master level clinician degree in behavioral health or human services, or equivalent experience (REQUIRED)
- Ability to obtain a direct/hardwired internet connection to a modem/router within 7 feet of the computer
- Minimum internet speed of 25 Mbps download and 3 Mbps upload
- WiFi and satellite internet are not permitted
- Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines
- Ability to work within the state and city where currently residing
- Ability to set up and use multiple monitors and navigate multiple applications
- Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
- Experience with Microsoft Office 365 applications or similar Google Workspace tools
- Ability to log in to secure systems such as VPN and EHR portals
- Ability to manage strong passwords and recognize suspicious emails or links
- Ability to resolve common technical issues independently
- Openness to learning new skills as the workplace environment evolves
Benefits:
- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- Company-provided equipment (keyboard, monitor, computer, headset, etc.)
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